Developments in Health Economics and Public Policy11 Pratima Ramful Srivastava Recreational Drug Consumption An Economic Perspective Developments in Health Economics and Public Policy Volume 11 Series Editors H.E.Frech III, UC SantaBarbara, USA PeterZweifel, UniversityofZurich,Switzerland Forfurthervolumes: http://www.springer.com/series/6039 Pratima Ramful Srivastava Recreational Drug Consumption An Economic Perspective 123 PratimaRamfulSrivastava SchoolofEconomics,Financeand Marketing RMITUniversity Melbourne Victoria Australia ISSN0927-4987 ISBN978-3-319-02404-2 ISBN978-3-319-02405-9(eBook) DOI10.1007/978-3-319-02405-9 SpringerChamHeidelbergNewYorkDordrechtLondon LibraryofCongressControlNumber:2013956427 (cid:2)c SpringerInternationalPublishingSwitzerland2013 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartof thematerialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation, broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionorinformation storageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilarmethodology nowknownorhereafterdeveloped.Exemptedfromthislegalreservationarebriefexcerptsinconnection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’slocation,initscurrentversion,andpermissionforusemustalwaysbeobtainedfromSpringer. PermissionsforusemaybeobtainedthroughRightsLinkattheCopyrightClearanceCenter.Violations areliabletoprosecutionundertherespectiveCopyrightLaw. Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthispublication doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromtherelevant protectivelawsandregulationsandthereforefreeforgeneraluse. While the advice and information in this book are believed to be true and accurate at the date of publication,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityfor anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with respecttothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Contents 1 Introduction .................................................................. 1 1.1 BackgroundandMotivation............................................ 1 1.2 ObjectivesoftheBook.................................................. 4 1.3 OutlineoftheBook..................................................... 6 2 LiteratureReview............................................................ 9 2.1 Introduction ............................................................. 9 2.2 Economists’FormulationofDrugConsumption...................... 10 2.3 DrugConsumption...................................................... 11 2.3.1 LicitDrugConsumption........................................ 12 2.3.2 IllicitDrugConsumption....................................... 18 2.4 Cross-DrugRelationships .............................................. 19 2.5 EconometricApproaches............................................... 21 2.6 DataIssues .............................................................. 22 2.7 Summary ................................................................ 23 3 AnOverviewofRecreationalDrugConsumptioninAustralia......... 25 3.1 Introduction ............................................................. 25 3.2 TheCostsofRecreationalDrugUse................................... 27 3.3 Data:TheNationalDrugStrategyHouseholdSurvey ................ 28 3.4 LicitDrugs .............................................................. 30 3.4.1 Alcohol.......................................................... 30 3.4.2 Tobacco ......................................................... 34 3.5 IllicitDrugs.............................................................. 37 3.5.1 Marijuana ....................................................... 37 3.5.2 Amphetamines.................................................. 39 3.5.3 Cocaine.......................................................... 39 3.5.4 Heroin........................................................... 40 3.6 IllicitDrugLawsinAustralia .......................................... 40 3.6.1 ChroniclesofIllicitDrugLawChanges....................... 40 3.6.2 AttitudestoDrugUseandDrugLaws......................... 43 3.7 Summary ................................................................ 43 v vi Contents 4 ModellingConsumptionofIndividualDrugs............................. 45 4.1 Introduction ............................................................. 45 4.2 EconomicandEconometricFramework............................... 46 4.3 LegalDrugConsumption............................................... 49 4.3.1 Alcohol.......................................................... 49 4.3.2 Beer,WineandSpirits.......................................... 55 4.3.3 Tobacco ......................................................... 60 4.4 IllegalDrugConsumption.............................................. 65 4.5 Summary ................................................................ 70 5 ModellingMultipleDrugUseUsingaMultivariateApproach......... 73 5.1 Introduction ............................................................. 73 5.2 TheMultivariateProbitModelforJointDrugParticipation.......... 74 5.3 Marijuana,Cocaine,Heroin,AmphetaminesandTobacco (MCHAT)Consumption:AMultivariateApproach................... 77 5.3.1 MCHAT: Observed Joint, Conditional andMarginalProbabilities ..................................... 78 5.3.2 MultivariateProbitEstimatesofMCHATConsumption ..... 78 5.3.3 MCHAT: Predicted Joint, Conditional andMarginalProbabilities ..................................... 82 5.3.4 MCHAT: Marginal Effects on Joint andConditionalProbabilities .................................. 82 5.4 Beer, Wine and Spirits (BWS) Consumption: AMultivariateApproach ............................................... 90 5.4.1 BWS:ObservedJoint,ConditionalandMarginal Probabilities..................................................... 91 5.4.2 MultivariateProbitEstimatesofBWSConsumption......... 92 5.4.3 BWS:PredictedJoint,ConditionalandMarginal Probabilities..................................................... 93 5.4.4 BWS:MarginalEffectsonJointandConditional Probabilities..................................................... 93 5.5 Summary ................................................................ 96 6 Modelling Alcohol Consumption by Levels Using anOrderedGeneralisedExtremeValue(OGEV)Model................ 99 6.1 Introduction ............................................................. 99 6.2 TheOGEVModelforLevelsofAlcoholConsumption .............. 100 6.3 EstimationResults ...................................................... 102 6.4 ComparisonwithOPandMNLModels............................... 107 6.5 Summary ................................................................ 112 7 DrinkingPatternsandEarnings ........................................... 115 7.1 Introduction ............................................................. 115 7.2 AMultinomialSelectivityModelforEarnings........................ 117 7.3 ModelEstimatesandEarningsPredictions............................ 120 Contents vii 7.3.1 DiscussionofResults........................................... 121 7.3.2 ObservedandPredictedEarningsUnderVarious ModelSpecifications ........................................... 126 7.4 EarningsDifferentials................................................... 127 7.4.1 Earnings Differentials of Non Bingers andFrequentBingersvis-a-visAbstainers .................... 128 7.4.2 Earnings Differentials of Non Bingers andAbstainersvis-a-visFrequentBingers .................... 128 7.5 Summary ................................................................ 130 8 Summary,PolicyImplicationsandFurtherResearch................... 133 8.1 SummaryofFindings................................................... 133 8.1.1 BingeDrinking ................................................. 134 8.1.2 WhoUsesWhatDrugsandHowMuch? DoPricesMatter?............................................... 134 8.1.3 ExploringCross-DrugRelationshipsViaBoth ObservableandUnobservableIndividualCharacteristics .... 137 8.1.4 AreFrequentDrinkersDifferentfromModerate or Occasional Drinkers? Can Advanced EconometricTechniquesEnhancetheAnalysis ofDrugConsumption? ......................................... 138 8.1.5 IsThereAnyAssociationBetweenIndividuals’ DrinkingBehaviourandTheirEarnings? ..................... 139 8.2 PolicyImplications...................................................... 139 8.3 LimitationsandPotentialFutureResearch ............................ 141 A DefinitionofVariables....................................................... 143 B AppendixtoChap.3......................................................... 147 C AppendixtoChap.5......................................................... 149 D AppendixtoChap.7......................................................... 161 Bibliography...................................................................... 165 Chapter 1 Introduction 1.1 BackgroundandMotivation The use of psychoactive drugs—licit and illicit—is associated with a range of adverse effects on both physical and mental health. Such health consequences range from short-term effects such as insomnia and abdominal pain to long- term effects such as seizures, strokes, paranoia, liver cirrhosis and heart disease (IHME 2013). Other than health effects, drug use is also associated with an array of adverse consequences on the user, his family and the community at large. Such consequencesinclude injuries or loss of life, family disruptions, poor job performance, road accidents, violence, crime and suicide. To put this into perspective, tobacco kills nearly 6 million people each year, including more than 600,000non-smokerswho die from exposure to tobacco smoke and up to half of the world’s one billion smokers will eventually die of a tobacco-related disease. Approximately2.3millionpeopleworldwidediedin2004,fromtheuseofalcohol. Between153and300millionindividualsaged15–64hadusedillicitdrugsin2010, out of which 15.5–38.6 million were problem drug users (UNODC 2012; WHO 2011a,b). Drug abuse imposes a high economic cost on society1 and has been a major concern to policymakers worldwide. A range of strategies, campaigns and rehabilitationprogramshavebeenundertakeninanumberofcountries,totreatand prevent drug-related harms. Such harms (to the user and to society) range from drug-related morbidity and mortality, motor vehicle fatalities, to violence, crime, andsuicide. In Australia, recreational drugs have a long-standing popularity despite the government’scommitmentto discouragethe uptake and supply of harmfuldrugs. Ithasoneofthehighestlevelsofalcoholconsumptionintheworld(WHO2011a). Over the last two decades, the National Drug Strategy (a cooperative venture 1Economiccostofdrugabuserelatestoexternalcostsarisingfromlostproductivity,healthcare expenditures,lawenforcementandcriminaljusticeexpenditures,etc. P.R.Srivastava,RecreationalDrugConsumption,DevelopmentsinHealthEconomics 1 andPublicPolicy11,DOI10.1007/978-3-319-02405-9__1, ©SpringerInternationalPublishingSwitzerland2013 2 1 Introduction between the Australian Commonwealth,State and Territory Governmentsand the Non Government sector) has developed a wide range of strategies towards harm reduction arising from drug consumption; produced and disseminated research for policy development and public awareness; and conducted national surveys to monitortheconsumptionofdrugs.In2004,nearlyhalfoftheAustralianpopulation, aged 14 or older, consumed alcohol and about one fifth smoked tobacco at least once weekly (NDSHS 2005a).More than 15% reportedthe use of illicit drugsin thepastyear,andmorethanathirdhadusedthematsomestageintheirlife.While marijuanaremainsthemostwidelyusedillicitdrug,mainlyduetolowprice(AIC 2013),syntheticdrugssuchasspeed,iceandecstasy,whichbelongtotheclassof amphetamines,have becomeincreasinglypopularin the last decade, in particular, amongyoungusers(Ransleyetal.2011). Drug abuse results in significant social and economic costs to the Australian society. In 2004–2005, drug misuse was estimated to cost Australians more than AUD56 billion (around 8.6% of GDP), of which AUD48 billion was attributed to licit drugsand AUD8 billion to illicit drugs(Collins and Lapsley 2008).These costs relate to resources used to address crime, health care, accidents and loss of potential productivity from disability, drug-attributed death and withdrawal from the workforce. They also include intangible costs resulting from psychological stressorlossoflife.Suchasignificantwasteofresources(resultingfromnegative externalities) can only be minimised with a well-designed set of cost-effective policiesandstrategies.Thus,fromapolicyperspective,itisveryimportanttohave athoroughunderstandingofdrugusersandtheireconomicbehaviour. The criminalstatus of illicitdrugsis a topicof heateddebateacrossthe world. It is argued that drug prohibition imposes a heavy economic cost on society in terms of legal and health care expenses when those resources could be released to better protect society from more serious crimes. On the other hand, opponents of drug decriminalisationor legalisation advocate that such policies only result in an increased use of drugs without bringing any social benefits to society. A few countries, or jurisdictionswithin some countries, have decriminalisedor legalised theuseofdrugs.InAustralia,thedecriminalisationofmarijuanahasstirredalotof controversy. South Australia was the first jurisdiction to implement an expiation system for minor marijuana offences known as the Cannabis Expiation Notice (CEN) system, in 1987. Under this scheme, simple marijuana offences such as possessing, or cultivating small amounts for personal use are subject to minor penalties although the sanctions for commercial dealings are rather significant. Similar expiation systems have since been introduced in a few other Australian states and territories and yet others have been gradually easing their laws against marijuanaconsumptionin recent years. Given Australia’s fairly recentexperience withdecriminalisation,thereisnotmuchempiricalevidenceinsupportofthepolicy anditsintendedeffect. Research on druguse andits consequenceshas arisenfromseveraldisciplines. Drug users’ behaviour has been studied extensively in psychology,sociology and medical arenas. In the last two decades economists have also showed growing interest in the study of drug use and its consequences.They have broughtunique